The focus of this blog is on the wonders of government-run health-care everywhere but I also note the damage done to private medicine by a legal system that supports predatory litigation.

The long-established socialized medicine systems in Britain and Australia are a particularly relevant warning about where such systems end up.

Posts by John J. Ray (M.A.; Ph.D.)

Thursday, September 24, 2009

NHS vendetta against whistleblower

No concern over whether staff were qualified, apparently. "Shoot the messenger" approach instead

A senior NHS nurse faced a “witchhunt” and was threatened with having her house burnt down if she did not drop a complaint against a colleague, an employment tribunal has been told.

Jenny Fecitt, who worked at an NHS walk-in centre in Wythenshawe, South Manchester, said that at the time of a phone call in which the threat was made she was in dispute with her employer after raising concerns over another nurse’s qualifications.

Mrs Fecitt had complained to bosses at NHS Manchester over one of the staff on her team, Daniel Swift, whom she claimed “misrepresented” his training and should not have been treating adult patients. But her concerns were ignored by trust bosses, it is alleged, and she was subjected to a “character assassination” before receiving the threatening call. “The substance of the call was if I did not drop the case against Daniel Swift that our house would be burnt down,” Mrs Fecitt told the employment tribunal, sitting in Manchester.

Mrs Fecitt, along with Annie Woodcock and Felicity Hughes, her fellow nurses, is taking NHS Manchester to the tribunal, claiming that they were victimised after voicing their concerns. The tribunal heard that problems began on March 3, 2008, after Mrs Woodcock approached her about Mr Swift’s qualifications.

Mrs Fecitt said that during a casual conversation among staff he maintained that he was qualified as both a child and adult nurse. She called the Nursing and Midwifery Council and was told that he was qualified to treat only children. Mrs Fecitt spoke to her line manager and, the next day, Mr Swift is alleged to have called her in an “aggressive and confrontational” manner.

She told the tribunal that it was her “moral and professional” obligation to report Mr Swift to the nursing council. She also contacted the trust’s officer responsible for corporate governance and whistleblowing in April 2008 and an investigation was started. But the following month she was relieved of her management responsibilities.

The New South Wales Opposition says nurses who have complained of bullying at a far south coast hospital would not mind if findings of an investigation were made public. Bega MP Andrew Constance says an external investigator's report on bullying and operational issues at Pambula Hospital should be given to the community.

The Greater Southern Area Health Service says the report will not be released publicly. However, a summary and set of recommendations will be released. Its eastern sector general manager, Ken Barnett, says staff and appropriate unions will be consulted before it is considered whether to implement recommendations.

Mr Constance says if unions are entitled to know the findings, so should the broader community, and nurses names could be omitted from the documents. "You don't necessarily need to disclose names but the community are entitled to know what occurred at the facility and what is going to be done about it in the future," he said. "The only way that the confidence can be regained by the community in what's occurring at Pambula Hospital is for that availability of the information and that openness and transparency around what's happened."

He says not releasing the investigation findings to the community will further erode public confidence in the health system. "I think nurses want accountability in the system. They want to be able to raise issues of concern and I think there's been enough secrecy clouding the hospital as is without it being furthered by a government not willing to be open and transparent about this report," he said. "The community is aware of the investigation. It's important that the community have the recommendations and the findings of that investigation."

As Barack Obama travels across the fruited plain and sucks up all the air on every Sunday network news show—except for FOX News Sunday—attempting to repackage his plans to take over the health care industry by force of law, one thing has remained constant. According to Dr. Obama, under his “plan,” tens of millions more Americans will receive taxpayer-subsidized health care, the quality of medical care will increase, and it will all occur at no extra cost to taxpayers. After that, he plans to walk on water.

In reality, of course, there are more than a few problems with the Obama Administration’s claims. Namely, the numbers simply do not add up. Expanding health coverage is a costly venture, and the American people are not fooled. They know they will wind up paying through the nose for this massive expansion of federal entitlements. And that these will add substantially to the national debt, which now totals some $11.8 trillion.

The House plan, which 45 million people qualify for, at an average cost of $4,700 per premium according to the National Coalition on Health Care, would add on $211.5 billion in extra costs to taxpayers every single year once fully implemented. That’s $2.1 trillion over ten years.

It doesn’t get much better even under the so-called “bipartisan compromise” legislation—that not a single Republican supports—now being floated by Montana Democrat Senator Max Baucus. Under his plan, an additional 26 million individuals would receive government-subsidized health care, which at $4,700 for a premium, adds up to $122 billion extra every year, or $1.2 trillion over ten years.

All of which will be piled atop the greatest budget deficit in human history: $1.85 trillion.

Both plans attempt to hide the unfunded entitlement costs by means of a deceptive scheme stalling fuller implementation of the public “option” on the House side, and the government-regulated co-ops on the Senate side. Each is delayed not to start until 2013. This execution is designed purely to keep the ten-year projections of each plan under the $1 trillion mark, thus providing political cover for members from more conservative districts and states.

The Baucus plan in essence attempts to deliver an ObamaCare Lite proposal that subtracts out the so-called public “option,” cutting the proposed increase of coverage by about 20 million individuals. His purpose is to find the votes necessary for Senate Democrats who are queasy about voting for what amounts to government-run socialized medicine.

In truth, they should still feel nauseous about casting Yay votes. The proposal establishes government-run ‘co-ops’ that will provide health care in place of private options. It still has a rationing board. It still requires Americans to be insured or else pay a fine. It still does not allow for competition across state lines to purchase medical insurance. It still expands Medicaid. It still increases taxes. It still has no tort reform. As noted above, it still adds to an already unsustainable debt. And, it will still ultimately result in a government-run system, no matter how much Barack Obama denies it.

Particularly devastating to both plans is that they will still inevitably result in rationing—one way or another. The American people are prospective in their outlook, and they are cautious about supporting a proposal that threatens to decrease the high quality of care they are used to receiving.

And Obama has not helped himself on this front.

Writes Dick Morris in a recent column in response to Barack Obama’s joint session of Congress address, “In his hour long speech on health care, [Obama] failed to spend even a moment rebutting the central critique of his program: His inability to provide quality medical care for 30 million new patients without any additional doctors or nurses… The result of expanding the demand for medical services without augmenting the supply of doctors or nurses must be the rationing of medical care. And rationing will inevitably take its greatest toll among the elderly, forcing them to forgo elective surgery or, if their remaining quality years are likely to be limited, to do without vital life-prolonging treatment. Inevitably, we will all have to wait many more days, weeks, months or years for care we now receive on demand.” During which time, one should add, they will die.

Another reason that both plans will result in rationing is that both contain provisions forcing insurers to take on riskier patients without charging more for the premiums. As a result, the costs will be passed on to everybody and distributed throughout the entire system.

In short, that means rates will go up. At the same time the quality of everyone’s coverage will decrease. And individuals will have no choice but to buy the watered-down plans. Soon, more will be allotted in benefits than can be collected in revenue. The program would then turn to borrowing and printing more money to fund it, as have Medicare and Social Security—a flawed approach that will bankrupt the public treasury.

And in the end, Washington will decide who gets care and who does not.

According to Rasmussen Reports, 56 percent of voters now oppose the plan, demonstrating a growing trend of opposition to the takeover. And Barack Obama’s public disapproval has sunk to the 52 percent mark for the first time in his term.

The fact is, the more Barack Obama parades around on television attempting to redesign and repackage his proposals to make them sound more appealing, the more the American people oppose him and his socialist designs. He has not deviated from the unsustainable path of socialized medicine he has chosen. He still cannot walk on water. Which is why his health care scheme is sinking like a rock.

The overriding characteristic of President Obama's healthcare proposal is forced equality of consumption, a major step in the direction of egalitarian distribution of income. Emphasis is upon the word forced.

As we see with the widespread town hall protests against the President's proposed healthcare proposals, people do not willingly surrender the fruits of many years' labor to the government in the name of an undefined abstraction called the common good. Particularly is this true when it is liberal-progressive bureaucrats who decide arbitrarily what constitutes the common good.

In a Wall Street Journal op-ed essay, Martin Feldstein, Harvard economics professor and former chairman of President Reagan's Council of Economic Advisors, sums up Obamacare: it's all about the raw power to decide who gets what treatment, while cramming everyone into identical little boxes in order to eliminate any efforts in the direction of individuality. And the bureaucratic mechanism for eliminating individuality is rationing medical care.

Despite the repeated lies by the President and his spokesmen, as Professor Feldstein writes, the healthcare bill pressed by House Speaker Nancy Pelosi clearly contemplates rationing.

Many supporters of Obamacare argue that healthcare already is rationed by money availability, because Medicare, Medicaid, and insurance companies will pay only certain amounts for care and will refuse to pay for some specialized treatments or prescription drugs. This ignores the obvious fact that individuals are free to make choices to pay for such care themselves and that it was individuals who selected the insurance payment programs they have.

Under Obamacare, all private insurance would eventually be compelled to offer exactly the same scope of insurance as the so-called public option. Everybody will be compelled to have the same coverage program, whether he is old, young, in poor health, or in good health.

The argument that medical care already is rationed also reflects a deep-rooted aspect of the liberal-progressive-socialist paradigm: the idea that individuals possessing more money than others is an inherently unjust social condition.

Michael Walzer's analysis of that paradigm is typical. Professsor Walzer, one of liberal-progressive-socialism's most prominent theorists, is co-editor of Dissent, a leading socialist journal.

Walzer contends that possession of money amounts to power and that such power is both unjust and unjustly used. It enables the rich to purchase every sort of social good. Why should these goods be distributed to people who have a talent for making money? This, he says, is morally implausible and unsatisfying.

Nor would it be better if we gave money to people on the basis of their intelligence, strength, or moral rectitude. There is no single talent or combination of talents that entitles a man to every available social good.

In the socialists' view, all that should count is need. If people need certain things (leaving aside how that need is determined), they should simply be given them, without regard to their ability to pay. This is what is meant, in Professor Walzer's sense, by social justice. Whenever equality in this sense does not exist, we have a kind of tyranny in which the strong, the well-born, and the wealthy get social goods in amounts that have little to do with their personal qualities or needs.

With respect to medical care, Walzer believes that it should be distributed only to those who are sick, without regard to wealth, intelligence, or righteousness. But in America today, it closely follows the income curve. "From each according to his abilities, to each according to his needs," would, however, be a fine slogan for medical care, he says. Taxes paid by all of us should pay doctors and other medical care providers. This, says Professor Walzer, necessitates a national health service of a sort to which Obamacare inevitably leads.

It isn't that every man should get what he deserves, as in the old definition of justice. The new standard is egalitarian: that is, everyone should have free and equal access to all the goods and services produced by our economy.

Liberal-progressive-socialists' goal is to restructure our political system to make a society of equals that is worth having. The starting point must be to end the tyranny of personal wealth.

A good doctor deserves society's praise, according to Professor Walzer, but that is no reason to pay him any more than any other worker. Why should a steelworker have to work much longer than a doctor for the money to have a home or an automobile? There are rewards intrinsic to the doctor's job, like the pleasure of using his specialized knowledge for the common good. That ought to be enough. There is no meritocratic defense for differences in pay.

As liberals like Professor Walzer see things, the rewards of the good life are social goods that the rich have habitually taken for themselves, without regard to any personal merit. They are merely the rewards that the upper classes throughout history have been able to seize and hold for themselves. Affirmative-action quotas are a way of redistributing these rewards by redistributing the social places that conventionally get the rewards. National Socialist healthcare is another.

When will the press notice President Obama’s hypocrisy when it comes to the “public option”?

Speaking at a community college in Troy, N.Y., on Monday, Obama slammed the banking industry for opposing his education bill, which passed the House last week. The bill would change the way the government subsidizes student loans. Under current law, the federal government insures banks against losses on the fixed-rate student loans known as Stafford loans. The government also pays banks a subsidy on these loans to offset their capital costs. In addition, the government offers a “public option,” under which students can borrow directly from the government at the same rates.

This option has been available since 1993, but students and universities overwhelmingly prefer the banks: The government’s share of new federally backed loan originations peaked at 30 percent right after the direct-lending program was created and has fallen steadily to 20 percent since then.

Obama wants to change that by making the government the sole provider — the “single payer,” if you will — of all federally subsidized student loans. He couches this policy change as cutting off an “unwarranted subsidy for the big banks.” So far, however, the press has failed to make the connection between this rhetoric and Obama’s pitch for health-care reform. The changes he wants in health care would make the market for health insurance look a lot like the market for student loans.

If Obamacare were to become law, everyone would be required to purchase a health plan. Those who couldn’t afford one would get a subsidy. Obama also wants to create a government-run public option so that people could purchase health insurance directly from the government. He says this would promote competition and keep the private insurers honest — which is exactly how Democrats defended the public option in student loans when it was created.

So let’s compare: Obama’s health-care plan would create a subsidy for private health-insurance companies akin to the subsidy for banks that he now calls “unwarranted” — the only difference is that the health-insurance subsidy would be delivered indirectly, by requiring people to purchase care and then paying for those who can’t afford it. Obama’s health-care plan would also let employers and individuals choose between private insurance and a public option, akin to the one the Democrats set up for student loans in 1993.

Here’s the question the press should be asking: If Obama thinks this arrangement is such a wasteful and inefficient way to subsidize student loans, why does he want to make it the way we subsidize health insurance? First, Obama is right to point out that subsidizing student loans costs the government a lot of money. But cutting out the banks merely allows the government to use accounting gimmicks to hide the costs.

Meanwhile, the subsidies are captured by the universities in the form of ever-rising tuition. Whether the government insures banks against default or, as Obama’s bill would do, directly assumes that risk, students who might not be good candidates for college are nevertheless approved for large amounts of financing. The resulting increase in demand has driven the cost of higher education skyward; worse, it has encouraged students to take on enormous debt loads that, depending on their aptitudes, they might not be able to repay. This is one lesson we can draw from the world of student loans and apply to Obama’s health-care plan: Government subsidies drive costs up, not down.

Another, even more important lesson to be drawn is this: “Public options” are Trojan horses for nationalization. Obama’s position on the public option for student loans and his position on the public option for health insurance are directly at odds. Why won’t anyone in the press call him on it?

1 comment:

The critical fact is that everybody DOES have catastrophic insurance, since emergency rooms don't turn dying people away.

The questions are thus (1) WHAT IF THEY DID TURN PEOPLE AWAY?, and (2) WHAT IF EVERYBODY HAD FULL COVERAGE (not just catastrophic)?

If our culture hardened and people dying on the street outside of hospitals was seen as a pathetic comeuppance for being born stupid and thus unworthy of support, then the absolute level of CASH FLOW going through both hospitals and insurance companies would plummet to a fraction of what it is now.

Less money flowing through a system means less profit. Insurance companies, especially, must be very happy to have cost be a MULTIPLE of what the actual cost per INSURED patient really is. It's as if they are living in the inflated future. Imagine taking your savings back 100 years. You'd be very rich!

Finally, does government want preventive medicine welfare while leaving the rest of the system alone? That's the cheapest option, meaning the least cash flow into and out of government, so the answer is a resounding NO.

Only the poor really want ONLY insurance welfare without medical socialism overall. The well off should want it too, since preventive maintenance would reduce their insurance greatly, but not under a government system that is politically activist and bureaucratic.

Who would have to turn into saints to avoid government intervention into what really is a problem? Insurance companies! They would have to provide income-based coverage to an extent that EVERYBODY has general care coverage and thus gets regular check ups (which would be a requirement as it is today, to get lower rates), and thus essentially free coverage to the poor, thus vastly reducing resource-intensive emergency care. Remember, they are ALREADY covering the poor with catastrophic coverage.

That, it seems to me is the "free market" solution. And that outcome, it seems to me, is utter fantasy.

In other words, insurance companies would have to start acting as central planners, meaning as governments!

I have not heard other enlightening, "wow I hadn't thought of that!" solutions based on unregulated trade between irrational participants, nor for coldly rational ones either.

Writing this type of essay feels very sophomoric. That indicates to me that this system is quite complex and centers very much on what there are only quite soft theories for in what ends up being economics and of sociology. It's also a pretty boring topic compared to other technical issues like nutrition or climatology. Why? Because there's no BIOLOGY in the debate, meaning no hard science to mull over and righteously stand upon in the great fight to find scientific truth in a world full of money-grubbing hucksters.

Background

Postings from Brisbane, Australia by John Ray (M.A.; Ph.D.) -- former member of the Australia-Soviet Friendship Society, former anarcho-capitalist and former member of the British Conservative party.

This blog gives a lot of attention to events in Australia and Britain -- places where there already exist systems similar to the one most likely to befall the USA if the Democrats get their way -- "Free" medical care supposedly available to all through government hospitals but with a competing private sector as well. The Canadian system is considered too Soviet to provide a likely model for the USA

TERMINOLOGY: Many of my posts concern the very instructive state of socialized medicine in Australia. Like the USA, Germany and India, Australia has a system of State governments which have substantial independence from the central (Federal) government and it is they who are mainly responsible for "free" health services. It may therefore be useful to some for me to note the standard abbreviations for the States concerned: QLD (Queensland), NSW (New South Wales), WA (Western Australia), VIC (Victoria), TAS (Tasmania), SA (South Australia).

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Conservatives do NOT object to helping the poor. Government welfare legislation in aid of the poor was in fact first introduced by conservatives -- Bismarck and Disraeli in the 19th century. What conservatives want is for the help to be delivered in a sane manner. And anyone who thinks that government bureaucracies can run hospitals well is completely out of touch with reality.

One of the oldest "free" public hospital systems in the world is that in the Australian State where I live: Queensland. It dates from 1944 (Britain's NHS began in 1948). So its advanced state of decay reveals well where the slow cancer of bureaucracy ends up. It now has three "administrative" employees for every medical employee. All those clerks are really good at curing people, I guess! Frequent bulletins on the flailing but ineffectual attempts to "fix" the system will appear here -- as well as bulletins on the dreadful things it does to patients and the long waits they endure.

On all my blogs, I express my view of what is important primarily by the readings that I select for posting. I do however on occasions add personal comments in italicized form at the beginning of an article.

I am rather pleased to report that I am a lifelong conservative. Out of intellectual curiosity, I did in my youth join organizations from right across the political spectrum so I am certainly not closed-minded and am very familiar with the full spectrum of political thinking. Nonetheless, I did not have to undergo the lurch from Left to Right that so many people undergo. At age 13 I used my pocket-money to subscribe to the "Reader's Digest" -- the main conservative organ available in small town Australia of the 1950s. I have learnt much since but am pleased and amused to note that history has since confirmed most of what I thought at that early age.

I imagine that the the RD is still sending mailouts to my 1950s address!

NOTE: The archives provided by blogspot below are rather inconvenient. They break each month up into small bits. If you want to scan whole months at a time, the backup archives will suit better. See here or here